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OPP III Exam II > Respiratory Cases (DSA and CIS) > Flashcards

Respiratory Cases (DSA and CIS) Flashcards

1
Q

how is the diagnosis of acute otitis media made (3 things)

A

acute onset of symptoms

evidence of middle ear effusion

signs and symptoms of middle ear inflammation

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2
Q

AOM that is recurring or that has treatment failure often is most likely associated with what?

A

S. pneumonia

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3
Q

how do you treat initial episodes of nonsevere AOM

A

high dose Amoxicillin

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4
Q

what do you use pharm wise for initial therapy in pt’s with SEVERE AOM

A

amoxicillin-clavulanate

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5
Q

when are tympanostomy tubes appropriate?

A

children who have persistent OME as well as for those who have risk factors for developmental delay or evidence of damage to the middle ear

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6
Q

what is the difference b/w AOM and OME

A

OME describes the presence of middle ear effusion without signs or symtpoms of infection

AOM = acute otitis media
infection of the middle ear with acute onset of signs and symptoms, MEE, and signs and acute symtpoms of middle ear inflammation

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7
Q

what is treatment failure AOM

A

lack of improvement within 48-72 hrs after initiation of antibiotic therapy

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8
Q

what is recurrent AOM

A

3 or more AOM episodes occurring in the previous 6 months or four or more AOM episodes in the preceding 12 months

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9
Q

what is the initial mechanism that triggers otitis media

A

impaired eustachian tube function such as occurs during

ACUTE:
URI, Gastroesophageal reflux, allergic rhinits

chronic:

  • craniofacial anomalies (Cleft palate)
  • shorter eustachian tubes of younger children
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10
Q

what is the most important predictor of AOM complicating a URI

A

Young age

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11
Q

what are the most common viruses involved in AOM

A

RSV

parainfluenza

influenza (A and B)

coronavirus

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12
Q

what are the most common bacterial infections associated with AOM

A

strep pneumoniae

H. influenzae

Moraxella Catarrhalis

S. pyogenes

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13
Q

what is tympanometry

A

measures the compliance of the TM

put the device in the ear and make air tight seal

the device transmits sound waves reflecting off theTM

energy reflected by these sounds waves is a measure of TM compliance

B curve- flat, meaning poor or no mobility and is usually associated with MEE (OME or AOM)

C- curve- near normal compliance, but the peak shifted towards negative pressures due to increasing negative pressures in the middle ear, generally a precursor to an effusion

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14
Q

which children are candidates for watchful waiting and skippin the antibiotics unless the pt worsens?

A

otherwise healthy children 6 months to 2 years of age with nonsevere illness at presentation and an uncertain diagnosis

AND

children 2 years of age and older without severe symptoms at presentation
OR
with uncertain diagnosis

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15
Q

how does OMT help with AOM?

A

a standard OMT protocol administered adjunctively with standard care for pt’s with AOM resulted in faster resolution of MEE at 2 weeks than standard care alone

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16
Q

what is the galbreath technique

A

simple mandibular manipulation that helps the middle ear drain and leads to quicker resolution of the problem

manipulating the mandible –> the physician increases blood flow to and through the region by alternately compressing and releasing the pterygoid plexus of veins and lymphatics in the region

with the pt sitting in the physicians lap, the pt’s “bad” ear is away from the physician and the doc uses his opposite hand (so if the pt’s right ear, then use docs left hand) and apply a downward and transverse force on the mandible that crosses the face

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17
Q

what is the difference b/w respiration and breathing ?

A

breathing –> move air from outside the body into the lungs, exchange oxygen in the air for carbon dioxide in the blood stream, and then exhale the air

respiration–> provide for a similar exchange of these gases at the cellular level

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18
Q

which dominates in the lungs:

parasympathetic or sympathetic

A

parasympathetic

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19
Q

facilitation level of lungs

A

T1-6

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20
Q

chapman’s point for heart

A

(myocardium)
Anterior:
2nd ICS close to the sternum on the right?

Posterior:
intertransverse space midway b/w spinous and transverse process of the 2nd and 3rd thoracic vertebrae

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21
Q

upper lung chapman’s points

A

3rd ICS (b/w 3rd and 4th ribs) close to sternum anteriorly

posterior:
intertransverse space ,midway b/w spinous and transverse process of the 3rd and 4th thoracic vertebrae

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22
Q

lower lung chapman’s point

A

Posterior:
intertransverse space ,midway b/w spinous and transverse process of the 4th and 5th vertebrae

Anterior 
4th ICS (b/w 4th and 5th ribs)
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23
Q

what are the hypersympathetic effects in the lung?

A

dilation of the bronchial tubes

epithelial hyperplasia –> goblet cells in the bronchial epithelium increase = more mucus that is thin watery

Sinus decongestion

24
Q

what is the outcome of having a flat diaphragm

A

decrease in pressure b/w the thorax and abd cavity–> decreased lymph flow increases congestion of tissues and can decrease CO

25
Q

initial manipulative treatment in pneumonia has what three main goals?

A

reduce congestion

reduce sympathetic hyperactivity to the parenchyma of the lung

reduce mechanical impediments to the thoracic cage respiratory motions

26
Q

what are some techniques used for the treatment of pneumonia

A

rib raising - focus on T1-T6–> helps make a more thin secretion

thoracic inlet - MFR

thoracolumbar area treatment

Diaphragm

27
Q

exhaled rib dysfunction is most frequently caused by what?

A

coughing

28
Q

treatment of the OA or AA makes patients more comfortable and normalize what?

A

parasympathetic influence to the lungs through the vagus

29
Q

what is included in the osteopathic manipulation plan for pt’s with lower pulmonary dysfunction

A

cervicals C3-C5 (phrenic n.)
sternum
T1-T12 and ribs 1-12
thoracolumbar junction

Sympathetics:
Rib raising T1-6
Chapmans

Lymphatics:
Thoracic inlet
Abd diaphragm
Rib raising
Lymphatic pumps

Parasympathetics:
-OA,AA, cranial- vagus

30
Q

T1-2

A

upper airway, head
Superior cervical ganglion- anterior to CV1 and CV2
Stellate ganglion (= inferior cervical and 1st thoracic)

31
Q

T2-6

A

= bronchioles, lungs

32
Q

Superior cervical ganglion

A

fused ganglia of C1 through C4

provides postganglionic innervation to the head and neck

33
Q

stellate ganglion

A

fusion of the inferior cervical sympathetic ganglion with the ganglion of T1

middle cervical and stellate ganglia innervate the heart, lungs, and bronchi

34
Q

where is parasympathetic innervation of the lungs and upper airways from?

A

vagus

35
Q

Pterygopalatine (Sphenopalatine) ganglia supplies what?

A

parasympathetic innervation to the sinuses, nose, lacrimal gland, and blood flow to the nasal mucosa.

by treating this you reduce congestion

36
Q

what does sympathetic stimulation cause in the airways

A

Response tends to be more general
Mucous glands and blood vessels are heavily innervated by the sympathetic nervous system
Smooth muscles are not
Stimulation of the sympathetic nerves in the mucous glands increases water secretion and
Decreases the viscosity of mucus.

Stimulation of the sympathetic system causes
Airway relaxation
Blood vessel constriction
Inhibition of glandular secretion
Increased release of water, which lowers the viscosity of mucus

37
Q

what does parasympathetic stimulation in the airways cause

A

slightly constricted smooth muscle tone in the normal resting lung
innervation is greater in the larger airways, and it diminishes toward the smaller conducting airways in the periphery
bronchial glands, increases the synthesis of mucus glycoprotein and
increases the viscosity of mucus

Stimulation of the parasympathetic system leads to
Airway constriction
Blood vessel dilation
Increased glandular secretion
Increased synthesis of mucus glycoprotein, which raises the viscosity of mucus

38
Q

what are muscles that work during inspiration

A

external intercostal

39
Q

what muscles are involved in expiration

A

internal and innermost intercostals

subcostals

transversus thoracis

40
Q

what is the effect of kyphosis on mechanical ventilation

A

Reduction of thoracic kyphotic angles demonstrated a reduced vital capacity, inspiratory capacity, total lung capacity, and lateral expansion (P<0.05).
There is also a significant negative correlation between the increased kyphotic angle and inspiratory capacity, vital capacity, and lateral expansion of the thorax.

41
Q

what are anterior chapman’s points for

A

diagnosis

42
Q

posterior chapmans points are for what

A

treatment

43
Q

bronchus chapmans points

A

(esophagus and thyroid): between ribs 2 and 3 close to the sternum

bronchus: midway between the tip of the transverse process and spinous process of T2 on the posterior aspect of the transverse process

44
Q

nose chapman’s

A

costochondral junction of 1st rib

nose: lateral aspect of the transverse process of C1

45
Q

tonsils chapmans

A

between 1st and 2nd ribs (1st intercostal space) close to the sternum

tonsils: posterior surface of C1 transverse process, midway between the nuchal ligament and lateral most aspect of the C1 transverse process

46
Q

sinuses chapmans’

A

3 ½” from the sternum, on the upper edge of 2nd rib and in the 1st intercostal space

sinuses: midway between the tip of the transverse and spinous processes of C2 on the posterior aspect of the transverse process

47
Q

middle ear chapmans

A

upper edge of the clavicle, just lateral where it crosses the 1st rib

middle ear: (otitis media) upper edge of the posterior aspect of the tip of C1 transverse process

48
Q

pharynx chapmans

A

front of 1st rib ¾-1” medial to where the clavicle crosses the1st rib

pharynx: midway between the spinous process and tip of the transverse process of C2, on the posterior aspect of the transverse process

49
Q

larynx chapmans

A

upper surface of 2nd rib, 2-3” lateral from the sternum

larynx: midway between the tip of the transverse process and spinous process of C2 on the posterior aspect of the transverse process

50
Q

tongue chapman’s

A

Tongue – front of 2nd rib cartilage ¾” from the sternum

51
Q

what is the purpose of the galbreath technique

A

Purpose – to increase blood flow through the pterygoid plexus of veins and lymphatics, drainage of the Eustachian tube, stretching of the peri-pharyngeal muscles and fascia

Patient supine (or seated in treating physician’s lap)
Affected side down (or away from physician’s treating hand)
Grasp mandible of affected side
Draw mandible downward and transversely with mild force for 3-5 seconds, repeating for 30-60 seconds
52
Q

vomer

sits where in the skull?
motion?
direction of movement?

A

The vomer is a midline bone that sits above the inter-maxillary (palatine) suture. Its motion is flexion and extension as it is driven by the motion of sphenoid.
The vomer moves in a postero-inferior direction during flexion and the opposite motion in extension.

It would be particularly obnoxious to palpate the vomer directly (deep to the soft palate).
Palpation is done at the cruciate ligament.
You can self-treat by placing your thumb pad over the cruciate ligament.
Gently resting your head on the thumb and your elbow on the table.
Wait for several cycles of flexion and extension for the vomer to be encouraged to resume its usual motion.

53
Q

what is the function of the vertebropleural ligament

and restriction of this can cause what!

A

The function of this “ligament” is to ensure that each lung is
equally aerated much like guide ropes on a hot air balloon.

Restriction here can limit lung 
function and C7 motion.
54
Q

somatic dysfunction of the thoracolumbar junction (especially flexed segments T10-L2) can cause what

A

increased sympathetic tone to the adrenal glands which can lead to weakening of the immune system if chronically present. Can also impair toxin excretion via the kidneys and intestines with chronic somatic dysfunction.

55
Q

what are the contraindications in treatment of resp problems in patients

A

1) No forceful direct treatments (depending on severity of illness)
2) HVLA to the thoracic spine relatively contra-indicated due to initial increase in sympathetic activity
3) Do not overtreat and tire the patient
4) Do not use treatment positions that aggravate patient’s breathing or pain (relative caution)
5) Thoracic pump technique in COPD patients
6) Visceral techniques in the acute phase

OPP III Exam II (5 decks)

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